Abstract

Objective To assess the cost–effectiveness of community-based
practitioner programmes in Ethiopia, Indonesia and Kenya.

Methods Incremental cost–effectiveness ratios for the three
programmes were estimated from a government perspective. Cost data were
collected for 2012. Life years gained were estimated based on coverage
of reproductive, maternal, neonatal and child health services. For
Ethiopia and Kenya, estimates of coverage before and after the
implementation of the programme were obtained from empirical studies.
For Indonesia, coverage of health service interventions was estimated
from routine data. We used the Lives Saved Tool to estimate the number
of lives saved from changes in reproductive, maternal, neonatal and
child health-service coverage. Gross domestic product per capita was
used as the reference willingness-to-pay threshold value.

Findings The estimated incremental cost per life year gained was 82
international dollars ($)in Kenya, $999 in Ethiopia and $3396 in
Indonesia. The results were most sensitive to uncertainty in the
estimates of life-years gained. Based on the results of probabilistic
sensitivity analysis, there was greater than 80% certainty that each
programme was cost-effective.

Conclusion Community-based approaches are likely to be
cost-effective for delivery of some essential health interventions where
community-based practitioners operate within an integrated team
supported by the health system. Community-based practitioners may be
most appropriate in rural poor communities that have limited access to
more qualified health professionals. Further research is required to
understand which programmatic design features are critical to
effectiveness.